Serum concentrations and side effects in psychiatric patients during risperidone therapy

Steady state serum concentrations of risperidone and 9-hydroxyrisperidone (9-OH-risperidone), the active moiety, were measured in 42 patients. The concentration-to-dose ratios (C/D) varied by a factor of 20, from 1.8 to 36.8 (nmol/l)/(mg/24 hours), and 90% of the active moiety was constituted of 9-OH-risperidone. No correlation between the serum concentration of the active moiety and the side effects evaluated by the UKU Side Effect Scale was found. The absence of CYP2D6 (poor metabolizers) or the coadministration of drugs other than benzodiazepines increased the ratio between parent compound and metabolite but did not significantly influence the C/D of the total active moiety. A therapeutic range for serum risperidone has not been established, but 6 mg/day is considered the optimum dose for most patients. The authors found that in 90% of 22 patients administered 6 mg/day risperidone, the serum levels were within 50 to 150 nmol/l.

An outbreak of Salmonella Typhimurium infections in Denmark, Norway and Sweden, 2008

In November-December 2008, Norway and Denmark independently identified outbreaks of Salmonella Typhimurium infections characterised in the multiple-locus variable number of tandem repeats analysis (MLVA) by a distinct profile. Outbreak investigations were initiated independently in the two countries. In Denmark, a total of 37 cases were identified, and multiple findings of the outbreak strain in pork and pigs within the same supply chain led to the identification of pork in various forms as the source. In Norway, ten cases were identified, and the outbreak investigation quickly indicated meat bought in Sweden as the probable source and the Swedish authorities were alerted. Investigations in Sweden identified four human cases and two isolates from minced meat with the distinct profile. Subsequent trace-back of the meat showed that it most likely originated from Denmark. Through international alert from Norway on 19 December, it became clear that the Danish and Norwegian outbreak strains were identical and, later on, that the source of the outbreaks in all three countries could be traced back to Danish pork. MLVA was instrumental in linking the outbreaks in the different countries and tracing the source. This outbreak illustrates that good international communication channels, early alerting mechanisms, inter-sectoral collaboration between public health and food safety authorities and harmonised molecular typing tools are important for effective identification and management of cross-border outbreaks. Differences in legal requirements for food safety in neighbouring countries may be a challenge in terms of communication with consumers in areas where cross-border shopping is common.

Invasive group A, C and G streptococcal disease in western Norway: virulence gene profiles, clinical features and outcomes

Invasive group A streptococcal (iGAS) disease is endemic in Norway, but data on invasive group C and group G streptococcal (iGCS/GGS) disease are lacking. We investigated the characteristics of iGAS and iGCS/GGS infections in western Norway from March 2006 to February 2009. Clinical information was retrospectively obtained from medical records. GAS and GCS/GGS isolates were emm typed and screened for the presence of 11 superantigen (SAg) genes and the gene encoding streptococcal phospholipase A₂ (SlaA). GCS/GGS isolates were also subjected to PCR with primers targeting speG(dys) . Sixty iGAS and 50 iGCS/GGS cases were identified, corresponding to mean annual incidence rates of 5.0 per 100,000 and 4.1 per 100,000 inhabitants, respectively. Skin and soft tissue infections were the most frequent clinical manifestations of both iGAS and iGCS/GGS disease, and 14 iGAS patients (23%) developed necrotizing fasciitis. The 30-day case fatality rates of iGAS and iGCS/GGS disease were 10% and 2%, respectively. emm1, emm3 and emm28 accounted for 53% of the GAS isolates, and these types were associated with severe clinical outcome. SAg gene and SlaA profiles were conserved within most of the GAS emm types, although five profiles were obtained within isolates of emm28. stG643 was the most prevalent GCS/GGS emm type, and speG(dys) was identified in 73% of the GCS/GGS isolates. Neither GAS SAg genes nor SlaA were detected in GCS/GGS. Our findings indicate a considerable burden of both iGAS and iGCS/GGS disease and a high frequency of necrotizing fasciitis caused by GAS in our community.

Meticillin-resistant Staphylococcus aureus in Norway, a low-incidence country, 2006-2010

BACKGROUND

Antibiotic resistance is a global public health threat. Norway has managed to keep the incidence of resistant bacteria at a low level in both the healthcare system and the community. Reporting of both individual cases and meticillin-resistant Staphylococcus aureus (MRSA) outbreaks is mandatory. All isolates are genotyped.

AIM

To describe the epidemiology of MRSA in Norway and to analyse how MRSA is spreading in a low-incidence country.

METHODS

All cases of laboratory-confirmed MRSA colonisation and infection reported in Norway from 2006 to 2010 were subject to epidemiological analysis.

FINDINGS

A total of 3620 cases of MRSA were found. Around one-third of the cases were imported, one-third acquired in the Norwegian healthcare system and one-third acquired in the community. Twelve percent of the cases were linked to known outbreaks. The total incidence of infected and colonized patients is slowly increasing. The numbers of severe infections remain stable at around 20 cases annually and the proportion of MRSA cases associated with healthcare has decreased.

CONCLUSION

MRSA is still rare in the Norwegian population and the strategic objective of preventing MRSA from becoming a permanent part of the bacterial flora in hospitals and nursing homes has so far been met.

Thyroid function during pregnancy with special reference to hydatidiform mole and hyperemesis

The thyroid function tests, serum protein-bound iodine (PBI), serum triiodothyronine reaction (T3-test) and serum cholesterol were measured in three groups of pregnant women: 1) 57 with normal pregnancy, 2) 35 with hyperemesis and 3) 14 with hydatidiform mole. A pattern of high values of PBI and T3-test and relatively low values of cholesterol in most of the patients with hydatidiform mole, and in almost one third of the patients with hyperemesis was found. A positive correlation of the volume of molar tissue and the values of PBI was observed. The treatment of patients with hyperemesis mostly resulted in normalisation of the thyroid function tests, while this was not the case in patients with mole. It is suggested that there might be a common cause of the thyroid stimulation in patients with mole and hyperemesis.

Molecular epidemiological investigation of an outbreak of invasive beta-haemolytic streptococcal infection in western Norway

During a decade-long, high endemic situation with severe group A streptococcal disease in western Norway, a cluster of 16 patients with invasive streptococcal disease was hospitalized during a period of 11 weeks. A study including clinical characteristics and molecular epidemiology of the outbreak was initiated. Relevant clinical information was obtained from the medical records of the patients. Nine of the 16 patients had soft tissue infection, and seven of these had streptococcal toxic shock syndrome (STSS). Mortality, both overall and among those with STSS, was 25%. Streptococcal isolates from these patients were characterized by serogrouping and emm sequence typing. The emm amplicons were further characterized by sequence analysis and restriction fragment length polymorphism (emm RFLP) analysis. The streptococci were identified as group A streptococcus (GAS) in 11 patients and group G streptococcus (GGS) in four patients. The patients with GGS infection were older than the patients with GAS infection, and all patients infected with GGS had predisposing comorbidities. Isolates from 13 patients were available for emm gene analysis and found to belong to nine different emm types. Similar differentiation was obtained with emm RFLP in GAS. Hence, the outbreak was polyclonal. Results suggestive of horizontal gene transfer and recombination between the emm genes of GAS, group C streptococcus and GGS were found in the isolates from seven patients. Such genetic recombination events suggest a possible role in pathogenesis.

Interaction of herpes simplex virus with mononuclear phagocytes is dependent on the differentiation stage of the cells

The interaction of herpes simplex virus (HSV) with mononuclear phagocytes (MP), i.e. monocytes and macrophages, is of importance for the pathogenesis of HSV infections. MP are known to play a significant role in the cellular defence against infections with HSV, but it has also been shown that HSV-1 affects MP. The infection of these cells at different stages of differentiation has different outcomes, and may result in the alteration of important cellular functions. HSV-1 inhibits the morphological differentiation of human monocytes, and this inhibition occurs in spite of the fact that human monocytes are non-permissive to HSV-1. We have studied the effect of HSV infection of monocytes and macrophages on production of essential cytokines and related this effect to the reproduction of the virus. Blood-derived MP were cultured in vitro and inoculated with HSV at different stages of differentiation. Replication of the virus was measured by infectivity titration, detection of HSV antigens by immunofluorescence and detection of HSV-specific mRNA. In monocytes, no viral replication and no production of late protein was seen. HSV IE gene was transcribed in monocytes from some donors, but not from others. In macrophages, virus replicated, but less efficiently than in fully permissive fibroblast cells. The production of IL-1 beta, IL-6 and TNF-alpha in both non-permissive monocytes and permissive macrophages was assayed both at the transcriptional level, as mRNA, and as protein released from the cells. Production of cytokines by MP was affected by HSV-1. The level of cytokine mRNA and cytokine protein did not correspond for all cytokines, which may suggest that translational regulation and/or cytokine inhibitors are important in the regulation of the cytokine response. The cytokine modulation, both at the transcriptional level and measured as biological activity, was different in monocytes and macrophages, and varied between different donors. Our results indicate a relation between permissiveness and cytokine response in mononuclear phagocytes infected with HSV-1. Such a relation may be of importance to both intrinsic and extrinsic defence mechanisms of MP against HSV-1. Our study also demonstrates that even the functions of non-permissive cells such as blood-derived monocytes may be affected by viral infections.

Prevalence surveillance system of nosocomial infections in Norway

In 1996, the Norwegian Ministry of Health issued regulations on the prevention of nosocomial infections (NIs). The regulations were revised in 2005. As part of the infection control programme, hospitals and long-term care facilities are obliged to have a surveillance system for NIs in place and to report the results to the Norwegian Institute of Public Health.

Severe case of invasive community-acquired methicillin-resistant Staphylococcus aureus infection in Norway

Staphylococcus aureus, including methicillin-resistant strains (MRSA), may cause a wide range of infections involving skin and soft tissue, as well as bone, airways, and endovascular grafts.

[The chemical working environment among car painters in Bergen]

Official guidelines have been prepared for the working environment in Norwegian spraylacquering garages, in order to reduce the incidence of symptoms and diseases related to exposure to organic solvents. 11 garages were visited to see if the guidelines were being followed. All the sprayers (n = 28) were examined by questionnaire about the occurrence of acute symptoms connected to the central nervous system, the skin, the eyes and the airways during work, and about their use of personal protective equipment. All the garages had specially ventilated rooms for the lacquering procedure, and all the workers used personal respiratory protective equipment. The sprayers did not report more acute symptoms than a control group of office workers employed in the same companies.

Herpes simplex virus type 1 inhibits in vitro differentiation and selected functions of human blood-derived monocytes

We have studied the effect of herpes simplex virus type 1 (HSV1) infection on in vitro differentiation of blood-derived human monocytes into macrophages using morphological, functional and biochemical parameters that alter during macrophage differentiation. Purified preparations of HSV modified the monocyte-macrophage differentiation, in spite of the fact that the virus did not replicate in monocytes. Disappearance of expression of a monocyte-specific surface antigen and the typical development of morphological appearance were delayed in HSV- infected cells. Production of the lysosomal enzyme acid phosphatase, which normally increases during differentiation, was also reduced in infected cells. Transcription of the oncogenes c-myc and c-fos, and the Hsp70 gene was modified in cells from some donors but not in other cell preparations. Possible mechanisms of these effects are discussed.

Identifying Future Study Designs for Mental Health and Social Wellbeing Associated with Diets of a Cohort Living in Eco-Regions: Findings from the INSUM Expert Workshop

Diets influence our mental health and social wellbeing (MHSW) in multiple ways. A rising community concept, Eco-Regions, has gained interest. The research project "Indicators for assessment of health effects of consumption of sustainable, organic school meals in Ecoregions" (INSUM) aims to develop future-oriented research approaches to measure the potential health effects of more sustainable and healthy diets. This first part of the project focuses on MHSW with the goal to identify suitable study designs and indicators. The methodology is based on a 2-day workshop with an interdisciplinary group of experts. This paper describes commonly applied research methods on the nexus between diet and MHSW as presented by the experts and summarises key points from the discussions. The results show that the dominating tool to investigate MSHW is questionnaires. Questionnaires vary largely depending on the research design, such as participants or distribution channels. Cohort studies addressing families and including in-depth interventional and/or experimental studies may be suitable for an Eco-Region investigation. Those MHSW studies can be conducted and combined with measurements of somatic health effects. We conclude that indicators should be seen as complementary rather than independent. Explorative research designs are required to investigate complex Eco-Regions.

Identifying Future Study Designs and Indicators for Somatic Health Associated with Diets of Cohorts Living in Eco-Regions: Findings from the INSUM Expert Workshop

Diets, but also overall food environments, comprise a variety of significant factors with direct and indirect impacts on human health. Eco-Regions are geographical areas with a territorial approach to rural development, utilizing organic food and farming practices, and principles and promoting sustainable communities and food systems. However, so far, little attention has been given to quantifying aspects of the health of citizens living in these sustainable transition territories. The project "Indicators for Assessment of Health Effects of Consumption of Sustainable, Organic School Meals in Eco-Regions" (INSUM) aims to identify and discuss research approaches and indicators that could be applied to effectively measure the somatic, mental, and social health dimensions of citizens in Eco-Regions, linked to the intake of organic foods in their diets. In this paper, we focus on the somatic (physical) health dimension. A two-day workshop was held to discuss suitable methodology with an interdisciplinary, international group of experts. The results showed the limitations of commonly used tools for measuring dietary intake (e.g., relying on the memory of participants), and nutritional biomarkers (e.g., variations in correlations with specific intakes) for research understanding dietary intake and the health effects of diets. To investigate the complexity of this issue, the most suitable approach seems to be the combination of traditional markers of physical and mental health alongside emerging indicators such as the microbiome, nutrigenomics, metabolomics, or inflammatory biomarkers. Using new, digital, non-invasive, and wearable technologies to monitor indicators could complement future research. We conclude that future studies should adopt systemic, multidisciplinary approaches by combining not only indicators of somatic and mental health and social wellbeing (MHSW) but also considering the potential benefits of organic diets for health as well as aspects of sustainability connected to food environments.

An outbreak of Salmonella Typhimurium infections in Denmark, Norway and Sweden, 2008

In November-December 2008, Norway and Denmark independently identified outbreaks of Salmonella Typhimurium infections characterised in the multiple-locus variable number of tandem repeats analysis (MLVA) by a distinct profile. Outbreak investigations were initiated independently in the two countries. In Denmark, a total of 37 cases were identified, and multiple findings of the outbreak strain in pork and pigs within the same supply chain led to the identification of pork in various forms as the source. In Norway, ten cases were identified, and the outbreak investigation quickly indicated meat bought in Sweden as the probable source and the Swedish authorities were alerted. Investigations in Sweden identified four human cases and two isolates from minced meat with the distinct profile. Subsequent trace-back of the meat showed that it most likely originated from Denmark. Through international alert from Norway on 19 December, it became clear that the Danish and Norwegian outbreak strains were identical and, later on, that the source of the outbreaks in all three countries could be traced back to Danish pork. MLVA was instrumental in linking the outbreaks in the different countries and tracing the source. This outbreak illustrates that good international communication channels, early alerting mechanisms, inter-sectoral collaboration between public health and food safety authorities and harmonised molecular typing tools are important for effective identification and management of cross-border outbreaks. Differences in legal requirements for food safety in neighbouring countries may be a challenge in terms of communication with consumers in areas where cross-border shopping is common.